Six Local Health Centers (LGZ) are currently being established in Hamburg to improve healthcare in socially and health-wise disadvantaged districts. The concept for the LGZs follow the PORT concept of the Robert Bosch Stiftung: The foundation has already been funding “Patient-Oriented Centers for Primary and Long-term Care” in Germany since 2015. The establishment of the Hamburg LGZ is funded by the Senate of Hamburg over a period of three years. The LGZs will operate at the interface of healthcare and social services. Characteristics are:

• Patient-oriented care in locally organized centers
• Cross-sectoral care
• Multiprofessional teamwork of medical, nursing and social counseling staff at eye level
• Interdisciplinary cooperation of local counseling centers
• Cross-sectional/primary counseling to improve the social situation
• Offers for prevention and health promotion
• Good integration in the districts

The Hamburg Social Authority and the Robert Bosch Foundation have concluded a cooperation agreement to evaluate the conception and implementation of the new centers in Hamburg. Together with the aQua Institute, inav GmbH is conducting an accompanying evaluation of the six LGZs. The aim of the evaluation is to provide scientific support for the transition of the primary care centers to regular care and to measure the achievement of the goals. The evaluation is based on a mixed-methods design and includes the following elements:

• Participant observation in all six LGZs
• Guideline-based interviews with stakeholders in the LGZs and in the districts
• Interviews with patients and users of the service
• Small-scale routine data analysis (impact analysis at district level)
• Secondary data analysis of the performance data of the LGZs

The evaluation is financed by the Robert Bosch Center for Innovative Health at the Bosch Health Campus in Stuttgart (formerly the health funding department of the Robert Bosch Foundation).

Physical activity has been shown to be one of the most important factors influencing mental and physical health, especially among elderly and high-aged people. However, the willingness to exercise declines with increasing age. At the same time, projections show that the number of elderly and high-aged people living in Germany will increase by 20 percent from 2015 to 2030.

This is one of the reasons why physical activity promotion is one of the priorities of the World Health Organization’s European Region Strategy for Physical Activity Promotion (2016-2025). This is also being addressed in Germany with the “Ich bewege mich – mir geht es gut!” (“I’m moving – I’m doing well!”) campaign.

The campaign, which is supported by the State Center for Health Promotion (LZG) in Rhineland-Palatinate e.V. in cooperation with the Rhineland-Palatinate Gymnastics Association and State Sports Association, provides information about the positive effects of physical activity in everyday life and is aimed at senior citizens. With the help of volunteer physical activity guides as multipliers, low-threshold physical activity programs close to home are to be implemented in public places and facilities and made easily accessible to the targeted group. The aim is to motivate the elderly and high-aged to engage in more physical activity and, at the same time, to prevent social isolation.

The aim of the evaluation, which will be conducted using the RE-AIM model, is to accompany the campaign in its implementation process, to provide support and to achieve a sustainability of the campaign. For this purpose, supporting and limiting factors are to be identified, which also consider the respective local conditions. Furthermore, the effect of the programs for the participating seniors will be examined.

The accompanying evaluation is funded by the SHI Alliance for Health – a joint initiative of the Statutory Health Insurance Funds for the further development of health promotion and prevention in life settings. The Federal Center for Health Education (BZgA) assigned the inav with the evaluation on behalf of the SHI Alliance for Health.

Photo: freepik

Around ten percent of children aged two to six are currently considered overweight and up to seven percent are considered obese. Overweight in early childhood is associated with the development of type 2 diabetes mellitus, lipid metabolism disorders, joint damage, high blood pressure, ischemic heart disease and bronchial asthma. Preventable risk factors, such as an unfavorable diet pattern and lack of exercise, as well as social disadvantages, are often responsible. They are especially manifested in children in families with a low social status. The risk of developing childhood obesity is three times higher here compared to peers with a high social status.

Daycare centers have become an essential environment for children outside the family. Therefore, they offer the opportunity to positively influence the development and course of health at an early age. The prevention concept Accredited Kindergarten for Physical Activity with the Plus Point Nutrition and the Add-on Module Mental Health (“Anerkannter Bewegungskindergarten mit dem Pluspunkt Ernährung”, ABmPE) includes programs for behavioral and environmental prevention and is intended to improve activity and nutrition behavior, especially in socially disadvantaged neighborhoods. Since the mental health of children is also of high relevance and the triad of contemporary health promotion for children is taught in a practice-oriented approach, these topics are complemented by the subject of mental health.

The ABmPE is an initiative of the state government of North Rhine-Westphalia (NRW) and the state’s statutory health insurance funds in cooperation with the NRW State Sports Association (Landessportbund NRW).

An already completed preliminary evaluation confirmed increased health awareness and improvements in physical activity and in food and beverage options at participating facilities.

The evaluation currently being conducted by the inav, funded by the SHI Alliance for Health and commissioned by the Federal Center for Health Education (BZgA), is focused, among other things, on the implementation of the mental health module. The aim is to highlight the benefits of the ABmPE project for the daycare centers and their providers, to demonstrate the effects of the nutrition element and to enable a sustainable implementation of the project.

Photo: freepic | nensuria

Vulnerable groups often have a greater need for preventive health care, but they are significantly less likely to engage in prevention and health promotion services. To be able to reach vulnerable groups, the SHI Alliance for Health recommends implementing interventions at the communal level. The “Confidence Coach” project is aimed at vulnerable populations and is being implemented at the municipal level in Rhineland-Palatinate. The aim of the project is to promote the competence to act and the personal responsibility of these groups and to encourage them to adopt a health-conscious behavior. The project’s target group includes elderly people, people with disabilities, people with a migration background, single parents, as well as children and young people from families struggling with addiction and/or mental health. Within the framework of this project, the groups of people listed above are sensibilized to the topic of health and exercise by qualified trust coaches (VC) and motivated to participate in health-promoting and primary preventive activities, especially regarding physical activity. The VCs can be located within the local municipality, welfare organizations, clubs, adult education centers, social insurance institutions, religious communities, etc.

The evaluation of the project is funded by the SHI Alliance for Health – a joint initiative of the statutory health insurance funds for the further development of health promotion and prevention in living environments. The Federal Center for Health Education (BZgA) on behalf of the SHI Alliance for Health has appointed the inav to evaluate the project. The aim of the evaluation is to examine how the project is implemented in the communities or settings, with regard to, e.g., the activities of the VC, the participation of the vulnerable target groups in physical activity programs, and supporting or inhibiting factors. It will also present how the project reaches the vulnerable target groups and the extent to which physical activity programs stimulate health and behavioural changes. The data collection will be carried out by qualitative and quantitative methods using a mixed methods approach.

Photo: freepik | shurkin-son

A significant proportion of elderly people have a core need to be able to live self-determined and as independently as possible in their own homes. At the same time, elderly people living alone tend to get injured, for example by falling. To address this, the World Health Organization recommends building a supportive environment in which the elderly can live independently without any restrictions.

The project Community Nurse ^plus adresses people aged 80+ who live in their own homes and require support. The goal of this project is to maintain their participation and self-determined life for as long as possible.

The activities of the professionals focus on:

• Outreach, preventive, and health-promoting counseling through preventive home visits
• Referral to appropriate additional support programs
• Strengthening regional and social networks and support programs
• Activation of existing resources of the very old and their environment to meet the challenges of aging
• Participation in the needs-oriented advancement of the communal and socio-spatial infrastructure
• Identifying and communicating local opportunities for support and participation

The sponsors of the project, which is implemented at the municipal level, are the Ministry of Labor, Social Affairs, Transformation and Digitalization Rhineland-Palatinate (MASTD) and the Rhineland-Palatinate statutory health insurance funds and health insurance associations of AOK, BKK, IKK, vdek, Knappschaft, SVLFG. The project was already implemented and evaluated in its first phase from 2015 to 2018 and has been in a second project phase from 2019 to 2021, which is currently being evaluated.

The Federal Center for Health Education (BZgA) appointed inav to evaluate the project on behalf of the SHI Alliance for Health. The main objectives of the evaluation, which is based on the RE-AIM model, are to examine the density of programs and services offered to the target group, to evaluate the implementation and realization process (as well as facilitating and inhibiting factors), and to assess the effectiveness of the project with regard to the project’s target group, the very elderly aged 80 and older without an existing level of care (“Pflegegrad”).

The evaluation uses both qualitative and quantitative survey methods and is structured in three modules.

1. Module: Online survey of those responsible for the project and the professionals of Community Nurse ^plus
2. Module: Focus groups and telephone interviews with representatives of the project sponsors, the professionals, and the project supervisors
3. Module: Written survey of the very elderly

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In Germany, adolescents have their first experiences with alcohol at an early age. In addition to personal reasons for drinking alcohol, there are structural conditions that promote or at least encourage adolescent consumption. A key factor influencing the consumptive behavior of adolescents is the availability of alcoholic beverages. Alcohol consumption can have serious health and social consequences. Despite the positive cumulative trend in recent years, the proportion of alcohol consumption that is associated with health risks has increased in Germany, particularly among young adults over the age of 18.

The prevention program “HaLT – Hard at LimiT” promotes quality-assured prevention of alcohol abuse by adolescents and young adults throughout Germany. The prevention program “HaLT – Hart am LimiT” stands for quality-assured prevention of alcohol abuse by adolescents and young adults throughout Germany. It is intended to promote the responsible consumption of alcohol. As of September 2020, there are 161 HaLT locations in 14 German states, operating under different organizational and financial frameworks. To ensure the quality of the nationwide program without losing sight of the individual needs of HaLT sites, the HaLT program has revised its framework. In the new module-based structure, additional modules and prevention programs have been integrated and quality management, quality development and network coordination aspects have been addressed. In addition, a new range of topics and target groups have been defined to be included in the HaLT program.

The evaluation of the HaLT program will not only include adolescents and young adults between the ages of twelve and 21, but also the professionals on site, multipliers, and the state and location coordinators of the program. The aim of the evaluation is to examine how the modules that have been developed around the new topics are implemented in the field and what facilitating and inhibiting factors are recorded during the implementation process. Data will be collected through qualitative and quantitative methods using a mixed-methods approach. In addition, the instruments of network and document analysis are used.

The evaluation during the implementation of the new framework concept is funded by the SHI Alliance for Health – a joint initiative of the statutory health insurance funds for the further development of health promotion and prevention in living environments. The Federal Center for Health Education (BZgA) has assigned the inav with the evaluation on behalf of the SHI Alliance for Health.

Photo: freepik | drobotdean

It is estimated that around six percent of all children and adolescents in Germany support their relatives in caring for a family member or bear the responsibility for care themselves. This is equivalent to approximately two adolescents per school class.

Often, this responsibility of support or care is experienced as stressful by the adolescents. In the long term, this can have a negative impact on the physical and mental health of the young people affected and, among other things, also negatively affect their educational opportunities or social life.

In order to avoid these negative effects and to strive for equal opportunities compared to peers without care responsibilities, the project “Truly irreplaceable” (“Echt unersetzlich”) pursues the goal of providing adolescents and young adults between the ages of 13 and 25 with a low-threshold counseling service. The counseling is provided free of charge and can be accessed via Internet, telephone, or on-site at the counseling center. The aim is to provide adolescents with hands-on and psychosocial counseling to support them in their everyday lives and living situations.

“Truly irreplaceable” is an initiative of the counseling center “Pflege in Not” (“Care in Need”) at Diakonisches Werk Berlin Stadtmitte e.V. (“Diaconal Service Berlin City Center”). The evaluation is sponsored by the SHI Alliance for Health – a joint initiative of the statutory health insurance funds for the further development of health promotion and prevention in living environments. The Federal Center for Health Education (BZgA) assigned the inav with the evaluation of the project on behalf of the GKV Alliance for Health. The main objective is to evaluate the training for professionals offered by”Truly irreplaceable” and the implementation of the counselling services.

For the collection of data, both qualitative and quantitative survey methods are used in a mixed methods approach. The evaluation focuses primarily on a process and outcome evaluation. This includes e.g. the evaluation of training courses for professionals and their implementation as well as the examination of existing obstacles for the practical implementation of the training contents. The evaluation also considers the perspectives of the individuals using the support services. In addition to counseling services, changes at the individual level are also considered. In addition, the outreach of the project is analyzed in association with the network and the public relations activities.

Photo: freepik | Yanalya

Today’s healthcare systems challenge people to make decisions regarding their health. In this context, the knowledge, motivation and competencies to access, understand, assess and apply the appropriate information are of high relevance. The underlying concept is defined as health literacy and is the requirement for making health-related decisions regarding appropriate care. Thus, health literacy is an important predictor of a person’s health status. In Germany, over one in two people has difficulty understanding health-related information. There is a correlation between limited health literacy and low social status.

The cities of Bremen and Bremerhaven are relevant locations for establishing programs to promote health literacy. In some city districts, inequalities are evident in living conditions and in terms of health and educational opportunities. To counteract these, the project “Health Professionals at Schools (GefaS)” has been implemented at Bremen and Bremerhaven elementary schools for some time. The goals of the current project include: strengthening the health resources of students, teachers and parents; creating a health-promoting school environment; increasing the school’s outreach to health-related services in the city district; and establishing and expanding network structures.

An in-process evaluation is often a central component of a complex intervention. The in-process evaluation of the project “GefaS” is funded by the SHI Alliance for Health and commissioned by the Federal Center for Health Education (BZgA) in the context of the evaluation of projects across different health insurance funds. The evaluation of “GefaS” will ascertain whether the underlying project has been successfully implemented and thus has the potential to be sustained to achieve long-term positive effects. Both qualitative and quantitative survey methods are used in a mixed methods approach. The focus is primarily on the evaluation of structures and processes. This includes, among other things, identifying the obstacles to project implementation at the schools, determining the factors that are beneficial to the implementation of the project, and assessing how the health professionals and the school staff and parents are cooperating with each other.